Sciatica: What you need to know

Sciatica is the name given to pain resulting from sciatic nerve irritation. Everything that irritates this nerve can cause pain, from mild to extreme. Sciatica is generally triggered to the lower spine by a compressed nerve.

The word “sciatica” sometimes gets confused with general back pain. Sciatica is not only restricted to the back, however. The sciatic nerve in the human body is the longest and broadest nerve. It runs across the buttocks from the lower back, down the legs and finishes just below the knee.

This nerve activates many lower leg muscles and provides stimulation to the skin of the foot and most lower legs. Sciatica isn’t a disorder but just a symptom of another sciatic nerve problem. Some researchers predict that at least once in a lifetime up to 40 per cent of people would experience sciatica.

Important facts about sciatica:

  • The sciatic nerve is the longest nerve in the human body.
  • The most common cause of sciatica is a slipped (herniated) disk.
  • Cognitive behavioral therapy can help some people manage the pain of sciatica.
  • Sciatica is not a condition; it is a symptom.

Symptoms of sciatica

Sciatica can cause pain in the back and legs.
Sciatica can cause pain in the back and legs.

The key symptom is a pain shooting through the sciatic nerve anywhere; from the lower back, through the buttock, and down the back of either leg.

Other common sciatic symptoms include:

  • numbness in the leg along the nerve
  • tingling sensation (pins and needles) in the feet and toes

This pain can range in severity and may be aggravated by sitting for long periods.

What are the treatments for sciatica?

We will look at treatments for acute and chronic sciatica individually:

Acute sciatica treatments

Most cases of acute sciatica respond well to self-care measures, which include:

  • Over-the-counter painkillers such as ibuprofen.
  • Exercises such as walking or light stretching.
  • Hot or cold compression packs help to reduce pain. It is often helpful to alternate between the two.

Not all painkillers are good for everyone; people should be careful to check their doctor’s options.

Chronic sciatica treatments

Chronic sciatica treatment typically requires a mix of self-care and medical treatment measures:

  • physical therapy
  • cognitive behavioral therapy (CBT) – helps manage chronic pain by training people to react differently to their pain
  • painkillers

If the symptoms have not reacted to other therapies and continue to worsen, surgery may be an option. Surgical options include:

  • Lumbar laminectomy – widening of the spinal cord in the lower back to reduce pressure on the nerves.
  • Discectomy – partial or entire removal of a herniated disk.

Depending on the cause of sciatica, a surgeon may be able to go beyond the risks and benefits of the procedure and recommend an acceptable surgical choice.

Exercises and stretches

There are many ways to ease the sciatic nerve pressure through exercise. That enables the patients to:

  • alleviate their symptoms on their own
  • reduce or avoid taking medications where possible
  • find longer term comfort and relief for their condition during flare-ups

In this video, a Madden Physical Therapy expert is looking at three sciatic nerve exercises:

Causes of sciatica

Sciatica is a typical symptom of many different medical conditions; however, a herniated (slipped) disk causes an estimated 90 percent of cases. The spinal column is composed of three components:

  • vertebra (individual bones in the spine that protect underlying nerves)
  • nerves
  • disks

Disks are made of cartilage, which is a substance that is solid and resilient; the cartilage serves as a barrier for each vertebra and allows the spine to flex. If a disc is moved out of alignment, a herniated disk occurs, putting pressure on the sciatic nerve.

Other causes of sciatica include:

  • Lumbar spinal stenosis – narrowing of the spinal cord in the lower back.
  • Spondylolisthesis – a condition where a disk slips forward over the vertebra below it.
  • Tumors within the spine – these may compress the root of the sciatic nerve.
  • Infection – ultimately affecting the spine.
  • Other causes – for instance, injury within the spine.
  • Cauda equina syndrome – a rare but serious condition that affects the nerves in the lower part of the spinal cord; it requires immediate medical attention.

In many cases of sciatica, there is no single obvious cause.

Risk factors for sciatic nerve pain

Common risk factors include:

  • Age – people in their 30s and 40s have a higher risk of developing sciatica.
  • Profession – jobs that require lifting heavy loads for long periods.
  • Sedentary lifestyle – people who sit for long periods and are physically inactive are more likely to develop sciatica, compared with active people.

Pregnancy

While sciatic-like pain can be an issue during pregnancy; an estimated 50–80 percent of women during pregnancy have back pain. Hormones released during pregnancy, such as relaxation, cause ligaments to loosen and stretch which in some women can potentially cause back pain.

However, sciatica due to a herniated disk is no more likely during pregnancy.

Outlook

In most cases sciatica will go away on its own; surgery is not required in the vast majority of cases. Within 6 weeks about half of people will recover.

Prevention of sciatica

In certain cases, sciatica can be prevented; there are many improvements in lifestyle that will minimize the risk of developing it, including daily exercise and ensuring that good posture is used while standing, sitting upright and carrying objects.

How is sciatica diagnosed?

If the symptoms of sciatica are mild and do not last more than 4-8 weeks, then acute sciatica is probable, and medical treatment is not normally needed.

A full medical history will help to accelerate diagnosis. Doctors may also have simple exercises performed by the person which stretch the sciatic nerve. A pain running down the leg when doing such exercises usually suggests sciatica.

If pain lasts for more than 4-8 weeks, it may be important to use imaging tests such as X-ray or MRI to help determine what compresses the sciatic nerve and causes the symptoms.

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